# Medical Advisory, Case & Fraud Management, Specialist

**Company**: AIA
**Location**: Kuala Lumpur, MY
**Experience**: senior
**Job type**: full-time
**Category**: Healthcare
**Industry**: Insurance
**Wikidata**: https://www.wikidata.org/wiki/Q30255387

**Apply**: https://aia.wd3.myworkdayjobs.com/en-US/External/job/Kuala-Lumpur-MY-AIA-Malaysia/Medical-Advisory--Case---Fraud-Management--Specialist_JR-37179?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_cdd9b62f-e97

## Description

We are looking for a Medical Advisory, Case & Fraud Management, Specialist to join our team in Kuala Lumpur.

Responsible for performing pre-certification; prospective, concurrent, and retrospective review of hospitalization; and to ensure cost containment measures are carried out without compromising on the care quality and service standards.

Key responsibilities:

- Pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company's requirements and guidelines

- Lead the team and manage rostering / OT and FTE count needed for AGL and ADR

- Ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned

- Achieve team target Savings benchmark

- Performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements

- Monitor of length of stay, reasonable and customary charges, to ensure there is no abuse in terms of admission and procedures During the adjudication of AGLs and ADR

- Mentor/coach and guide the TLs and assessors in robust decision making

- Ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors

- Participate in outlining Medical training /roll downs according to the needs of the staffs

- Participate in analysis and audits that are pertinent to cost savings across various units in AIA

- Participate in process improvement initiatives pertaining to system enhancement and refining process flow for the team

- Collaborate with various units in AIA in ensuring cost savings and CAR is achieved

- Participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse matters

- Lead the Fraud, Waste and Abuse initiatives in conducting analysis

## Skills

### Required
- medical advisory
- case management
- fraud management
- cost containment
- team leadership

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Source: [Apply at aia.wd3.myworkdayjobs.com](https://aia.wd3.myworkdayjobs.com/en-US/External/job/Kuala-Lumpur-MY-AIA-Malaysia/Medical-Advisory--Case---Fraud-Management--Specialist_JR-37179?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)